title: Physician allocation of Medicare resources for patients with advanced cancer.
abstract: BACKGROUND
  Little is known about what patients and physicians value in end-of-life care, or how these groups would craft a health plan for those with advanced cancer.
  
  
  OBJECTIVE
  The study objective was to assess how otolaryngology, head and neck surgery (OHNS) physicians would structure a Medicare benefit plan for patients with advanced cancer, and to compare this with cancer patient and cancer patient caregiver preferences.
  
  
  METHODS
  OHNS physicians used an online version of a validated tool for assessing preferences for health plans in the setting of limited resources. These data were compared to cancer patient and caregiver preferences.
  
  
  METHODS
  OHNS physicians nationwide were assessed with comparison to similar data obtained in a separate study of cancer patients and their caregivers treated at Duke University Medical Center.
  
  
  RESULTS
  Otolaryngology physicians (n=767) completed the online assessment and this was compared with data from 146 patients and 114 caregivers. OHNS physician allocations differed significantly in 14 of the 15 benefit categories when compared with patients and caregivers. Physicians elected more coverage in the Advice, Emotional Care, Palliative Care, and Treatment for Cancer benefit categories. Patients and their caregivers elected more coverage in the Cash, Complementary Care, Cosmetic Care, Dental and Vision, Drug Coverage, Home Improvement, House Calls, Nursing Facility, Other Medical Care, and Primary Care benefit categories.
  
  
  CONCLUSIONS
  Otolaryngology physicians have significantly different values in end-of-life care than cancer patients and their caregivers. This information is important for efficient allocation of scarce Medicare resources and for effective end-of-life discussions, both of which are key for developing appropriate health policy.
authors.affiliation: Department of Surgery, Division of Otolaryngology, Head, and Neck Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Rocke
authors.forename: Walter T
authors.initials: WT
authors.lastname: Lee
authors.forename: Halton W
authors.initials: HW
authors.lastname: Beumer
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.forename: Kristine
authors.initials: K
authors.lastname: Schulz
authors.forename: Steven
authors.initials: S
authors.lastname: Thomas
authors.forename: Liana
authors.initials: L
authors.lastname: Puscas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D016009:Chi-Square Distribution; D005260:Female; D006292:Health Priorities / Q000191:economics* / Q000592:standards; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D009657:North Carolina; D010036:Otolaryngology / Q000191:economics / Q000592:standards; D010166:Palliative Care / Q000191:economics* / Q000592:standards; D057240:Patient Preference; D040841:Resource Allocation / Q000379:methods / Q000592:standards; D019452:Terminally Ill; D014481:United States; D000078329:Workforce